Bone Marrow or Stem Cell Transplant in Children

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KEY POINTS

• A bone marrow transplant or stem cell transplant is a treatment for some types of cancer, problems with the immune system, and other bone marrow problems. Marrow is the soft, fatty tissue inside the hard bone where blood cells are formed. Stem cells are young blood cells that can become red blood cells, white blood cells, or platelets.
• Follow all of the instructions provided by your child’s healthcare provider. Ask any questions you have before the procedure. You should understand what your child’s healthcare provider is going to do.
• Ask your child’s healthcare provider how to take care of your child at home.

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What is a bone marrow or stem cell transplant?

A bone marrow transplant or stem cell transplant is a treatment for some types of cancer, problems with the immune system, and other bone marrow problems. The immune system is your body’s defense against infection. Marrow is the soft, fatty tissue inside the hard bone. The marrow is where blood cells are formed.

• White blood cells help fight infection.
• Red blood cells carry oxygen and nutrients to your child’s body.
• Platelets help your child’s blood clot.

Stem cells are young blood cells that can become red blood cells, white blood cells, or platelets. Most stem cells are in the bone marrow, but some are in the bloodstream. Blood in the human newborn umbilical cord also contains stem cells. Stem cells from any of these sources can be used for transplants.

When is it used?

A bone marrow or stem cell transplant may be done to:

• Help your child’s body make more blood cells
• Help your child’s body fight disease
• Replace diseased or destroyed bone marrow with normal bone marrow

Stem cell transplants may be used to treat:

• Leukemia
• Myeloma
• Lymphoma
• Neuroblastoma
• Immune system problems that your child was born with
• Certain kinds of anemia
• Sickle cell disease

Researchers are studying stem cell transplants to see if they will help with other diseases.

How do I prepare my child for this procedure?

• Plan for your child’s care and find someone to help at home after the procedure if needed.
• If your child needs to take a medicine before donating stem cells, make sure that your child takes the medicine exactly as prescribed.
• Your child may or may not need to take regular medicines the day of the procedure, depending on what they are and when your child needs to take them. Tell your healthcare provider about all medicines and supplements that your child takes. Ask your healthcare provider if your child needs to avoid taking any medicine or supplements before the procedure.
• Your healthcare provider will tell you when your child should stop eating and drinking before the procedure. This helps to keep your child from vomiting during the procedure.
• Follow all of the instructions provided by your healthcare provider.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do. You have the right to make decisions about your child’s healthcare and to give permission for any tests or procedures.

What happens during the procedure?

The bone marrow or stem cells are collected from a donor or from your child’s blood before your child has chemotherapy or radiation therapy.

Before stem cells are collected from your child’s blood, your child will be given medicine for a few days to help the body make more blood forming cells. Stem cells will be taken from a large vein in your child’s arm or through a tube placed in a vein in the neck, chest, or groin. The blood goes through a machine that separates the stem cells from the rest of the blood. The remaining blood is returned to your child through another vein. Collecting stem cells from your child’s blood takes about 4 to 6 hours. It can be done at an outpatient clinic. Stem cells can be frozen and stored until they are needed.

Bone marrow is usually collected from both hipbones with a needle. Your child will be given regional or general anesthesia to keep from feeling pain during the procedure. Regional anesthesia numbs part of the body while your child stays awake. General anesthesia relaxes your child’s muscles and puts your child into a deep sleep. The procedure to collect bone marrow takes about an hour.

When it is time for the transplant, the bone marrow or stem cells are given through a vein (IV), like a blood transfusion. The transplant takes 1 to 5 hours.

What happens after the procedure?

The medicine used to help your child’s body make more blood forming cells may cause side effects such as fever, bone and muscle aches, headaches, tiredness, nausea, vomiting, and trouble sleeping. These side effects generally go away in 2 to 3 days after the last dose of the medicine.

After your child donates bone marrow, the area where the marrow was taken out may feel stiff or sore for a few days, and your child may feel tired. Within a few weeks, your child’s body will replace the donated marrow. Some children are back to their usual routine within 2 or 3 days, but others may need 3 to 4 weeks to fully recover their strength.

When your child is given a transplant, the stem cells start to make new, healthy blood cells in 2 to 4 weeks. During this time, your child may be given medicine or blood transfusions to prevent problems.

After the transplant, your child will have blood tests to see how well your child’s bone marrow is making new blood cells. Your child may also have a test called bone marrow aspiration, which is the removal of a small sample of bone marrow through a needle for examination under a microscope. This helps your provider see how well your child’s bone marrow is producing new cells and platelets.

Although your child’s body will start making new blood cells in 2 to 4 weeks, it will take much longer for the immune system to recover completely. It could take up to several months if your child’s own stem cells are used and 1 to 2 years if the stem cells were donated by someone else. Your child may need to stay away from school and other places due to the danger from infections such as colds and flu.

What are the risks of this procedure?

If your child’s own cells are used for the transplant, there are usually no serious risks other than the risks of the general or regional anesthesia used during the procedure. Discuss the risks of anesthesia with your healthcare provider. When your child receives his or her own stem cells in a transplant, there is no risk from anesthesia because anesthesia is not needed.

• It may be harder for your child’s body to fight infections.
• Your child may have side effects from chemotherapy or radiation treatments received before your child had the stem cell transplant.
• If your child’s own cells are used for the transplant after treatment for cancer, there may be cancer cells among the transplanted stem cells.

When your child receives cells from another person:

• The stem cells may die or be destroyed by your child’s immune system before they can settle into your child’s bone marrow, which is called rejection.
• A complication known as graft-versus-host disease (GVHD) sometimes develops. GVHD occurs when white blood cells from the donor attack your child’s cells. This can damage some parts of the body, such as the skin, liver, and intestines. It may happen within a few weeks of the transplant or much later. Your child may be given medicines that suppress the immune system to help prevent GVHD.
• There is a small risk of infection from the donated cells.

Ask your healthcare provider how these risks apply to your child. Be sure to discuss any other questions or concerns that you may have.

For more information, contact:

• Leukemia & Lymphoma Society
  800-955-4572
  http://www.lls.org/
• National Cancer Institute
  800-422-6237 (TTY: 800-332-8615)
  https://www.cancer.gov/
• American Cancer Society, Inc.
  800-227-2345
  https://www.cancer.org/
• National Marrow Donor Program (NMDP)
  800-627-7692
  https://bethematch.org/